Valsartan

(73rd Scientific Sessions of the American Heart Association) According to results of the Valsartan Heart Failure Trial (Val-HeFT), the combined risk of death and morbidity in patients with heart failure can be significantly reduced by adding the angiotensin II receptor blocker valsartan to standard treatment (including angiotensin-converting enzyme [ACE] inhibitors, beta blockers, diuretics and digoxin). The Val-HeFT study was a randomized, double-blind, placebo-controlled trial that included 5,010 patients from 300 centers in 16 countries. The participants were 18 years or older (mean age: 62 years) with mild to severe chronic heart failure, an ejection fraction of at least 40 percent and left ventricular diastolic transverse diameter greater than 2.9 cm per m2, and most (4,005) were male. Patients were randomized to receive valsartan titrated to a target dosage of 160 mg twice daily (2,511 patients) or placebo (2,499 patients) while continuing all other appropriate therapies, which included ACE inhibitors in 93 percent of patients, beta blockers in 36 percent, diuretics in 86 percent and digoxin in 67 percent. In patients receiving valsartan, combined mortality and morbidity from heart failure decreased by a significant 13.3 percent, and this benefit was especially significant in patients who were not receiving beta blockers or ACE inhibitors. The rate of all-cause mortality was similar between the two groups. Patients receiving valsartan had a 27.5 percent reduction in the number of hospitalizations for heart failure, experienced a better quality-of-life as measured by the Minnesota Living with Heart Failure questionnaire, and showed a 22.9 percent improvement in their New York Heart Association (NYHA) classification, indicating favorable effects on disease progression. The rate of discontinuation because of side effects was only slightly higher in patients receiving valsartan (9.9 percent) compared with patients receiving placebo (7.2 percent). The most common adverse events were dizziness, hypotension and renal impairment.--JAY N. COHN, M.D., University of Minnesota Medical School, Minneapolis, Minnesota.

COPYRIGHT 2001 American Academy of Family Physicians
COPYRIGHT 2001 Gale Group